Figure 10

X-ray Fused with MRI (XFM) guided repair of a membranous ventricular septal defect in swine[167]. Panel A shows traditional X-ray contrast left ventriculogram highlighting ventricular septal defect (VSD; thick, white arrow). Panel B shows turbo spin-echo 3 chamber view, which highlights the VSD (thick, white arrow) in the same orientation as X-ray image in panel A. MRI regions of interest were segmented manually to be presented to the operator as a static image overlay on real-time X-ray fluoroscopic images. Panel C is a schematic depicting a new XFM guided antegrade approach to crossing the VSD in order to close the defect with a nitinol implant. XFM roadmap (Panel D) elements include the right ventricular endocardial contour (yellow), the left ventricular epicardial contour (green), the left ventricular endocardial contour (blue), the VSD tract (red outline and black arrow), aortic root (red), and aortic valve (blue annulus with white leaflets). The guidewire (white arrowhead) is delivered across the VSD and into the aorta.